2012 Fall Seminars

Seminar #1: Health Care Politics and the 2012 Elections

Faculty: Jonathan Oberlander, PhD Politics And Health

Professor of Social Medicine

Professor of Health Policy & Management

Adjunct Professor of Political Science

Time: Tuesdays 1:00-2:50 (FALL)

Seminar Description:

This seminar explores issues and controversies in health policy and the politics of health care reform.  This is an extraordinarily important—and compelling—time in American health care, a time of tremendous change and instability.  We will pay special attention this fall to the 2012 elections and the health reform law enacted by Congress and the Obama administration in March 2010 (the Affordable Care Act).  We will study how the law aims to change the U.S. health care system, its strengths and weaknesses, the role of health care in the 2012 elections and how the elections could reshape the future of American health care.

We will also discuss political and legal battles over repealing the Affordable Care Act, including the forthcoming Supreme Court decision on the ACA’s constitutionality, challenges in implementing health reform, and changes in how doctors and hospitals are being paid by both public and private insurers.

The seminar will answer fundamental questions such as:  Why is it so hard to reform the U.S. health care system? Why did health reform pass in 2010 after a century of (mostly) failure? What impact will the Affordable Care Act have on insurance coverage and health care costs?

How do other nations deliver and finance medical care and what can we learn from their experiences?  What are the options for controlling the costs of medical care? And how can the U.S. reform its malpractice system and improve the quality of medical care?

These issues impact the medical profession and throughout the seminar we will discuss what the changes in the health care system mean for physicians.  We will also focus on how American politics shapes our health policy.

By the end of the course, you will have a deeper understanding of:  how the U.S. health care system works (and doesn’t work), how and why we developed this system and the history of health reform, the strengths and weaknesses of the 2010 health reform law, the political challenges facing the Democrats and Republicans as they attempt to transform American medical care, and options for reforming or replacing the Affordable Care Act.

Course readings will draw from health policy and medical journals, as well as book chapters, and will reflect a wide range of disciplines.

Seminar Topics:

  • The Obama Administration & Health Reform
  • Repealing Health Reform: The Legal and Political Battles
  • How Will the Affordable Care Act Change the U.S. Health System?
  • Politics of Health Reform and the 2012 Elections
  • International Health Systems
  • Quality of Care
  • Malpractice Reform
  • Health Care Cost Control
  • Medicare, Medicaid & the Federal Deficit
  • Accountable Care Organizations & Delivery System Reform

Seminar Requirements:

  1. Active Participation in class discussions.
  2. Co-lead one session with other students.
  3. Write two short papers (about 7 pages each) on health policy issues.

 

Seminar #2: Exploring The ‘Other Side’: Experiences of Deviance, Disability and Chronic Illness

Faculty: Sue E. Estroff, PhDThree Views

Professor of Social Medicine

Adjunct Professor of Anthropology and Psychiatry

Course Director of Medicine and Society

Time: Tuesdays 1:00-2:50 (FALL)

Seminar Description:

This is a seminar about persons with stigmatized conditions—people whose lives are at once extra-ordinary and commonplace, unexpected and average.  This is a semester-long exploration and discussion of individuals who are defined as deviant, and who experience disabilities and chronic illnesses.  Deviance involves offenses to the moral and social body, disability implicates the physical and individual body.  Much of deviance is related to the body, either directly or indirectly, with bodily conditions invoked as the evidence for or consequence of deviance and disablement.  As a result, medicine as a body of knowledge and practice, and physicians as clinicians, define, identify, and treat deviance AND disability—from obesity to alcoholism to paraplegia to schizophrenia.

We will examine social, personal, and medical responses to individuals with enduring, de-valued differences in anatomy, appearance, functioning, and behavior.  Our reading and discussions will include first person accounts or illness narratives, clinical and social science research, and the images of disabled and deviant persons in literature and film.  The class will also draw on the perspectives of families and relatives of disabled persons, as well as popular culture and humorous views of these subjects.  Advocacy, self-help, public policy, and individual economies (employment, health insurance, and other material resources) are also examined.  Seminar participants with a special interest in a particular type of deviance or disability are encouraged to pursue relevant fieldwork experiences.

Seminar Topics:

  • How Chronic Illness is Experienced and How Deviance is Created, Understood, and Experienced
  • Medicalization, Responsibility, and Stigma: The Case of Addictions
  • Making Perfect People?  Prenatal Screening, Diagnosis, and Treatment
  • On Passing, and Being Blind and Hearing Impaired
  • Wheeling Around in an Ambulist World:  Mobility Impairments
  • Aesthetics and Disability: Bodily Shape, Form, Function, Mobility and Sexuality
  • Mind/Body, Gender/Sexuality and Difference/Deviance
  • Mad or Bad?  Criminality as Deviance or Disease
  • Chronic illness, disability, and kinship: How do families cope with and participate in the long
  • term health problems of family members?
  • Mental Illness: Experiences of Recovery and of Suffering
  • Disability Policy or Disabled Policy?
  • And how shall we let them die?

Seminar Requirements:

  1. Teaching, class participation and presentations 40%
  2. Field report, book or film review 30%
  3. Journal or paper 30%

Seminar #3: The Revenge of the Sick: History of Medicine from the Patient’s Point of ViewInfant Patient

Faculty: Raúl Necochea, PhD

Assistant Professor of Social Medicine

Time: Tuesdays 1:00-2:50 (FALL)

Seminar Description:

Injury, disease, and bodily decay predate modern medicine and have interested individuals other than medical doctors for centuries. This course deals with how knowledge about disease has been produced, and how it has evolved and changed us as it circulates worldwide.

We will discuss the origins and evolution of major medical theories (e.g. humors, germs) and forms of intervention (e.g. vaccination, birth control) in relation to their socio-historical context (e.g. colonialism, the Cold War). Along the way, students will be exposed to the wide array of groups and individuals who have played a role in our contemporary knowledge of illness, including unlicensed practitioners, the military, priests and nuns, device manufacturers, and, especially, the sick themselves.

Our two main goals will be to understand (1) the ways in which Western medicine has become a global political and cultural phenomenon; and (2) how different social actors have parsed the distinction between sickness and health over time. Focusing on the sick and the ways they have confronted disease, bodily decay, and physical discomfort enriches our understanding of the specificity of modern medicine, and helps explain why modern medicine co-exists with other forms of behaviors to care for oneself and others, including diet, homeopathy, and prayer. At the same time, it is undeniable that modern Western medicine has become a singularly powerful way to view and act on illness. The distinctive strengths and weaknesses of Western medicine have not emerged in a vacuum, but in relation to alternative healing traditions, commercial opportunities, political debates, and wars. In other words, the world of medical practice has always been intimately connected to other spheres of social action, able to influence them, and influenced by them in turn.

It is tempting to look at the past as a guide for how to act in the present. The course will resist such temptation by considering instead how the globalization of Western medicine and the experience of sickness do not belong in the past, providing us with “lessons”, but are instead part of an unfolding present in which students are learning to become physicians. The course will encourage students to reflect continuously on the importance of the passage of time as a dimension of medical practice, asking questions such as what changes?, what remains?, and why? In addition, students will be introduced to the historical analysis of primary sources, an essential component to both the critique and the writing of history.

Evaluation will consist of participation in seminar discussions, and two short writing assignments, one using primary sources, and one using secondary ones.

Seminar #4: Health and Human Rights: Selected TopicsStethoscope

Faculty: Jeffrey Sonis, MD, MPH

Associate Professor of Social Medicine

Associate Professor of Family Medicine

Time: Tuesdays 1:00-2:50 (FALL)

Seminar Description:

In the last 25 years, there has been a growing realization that there are strong connections between health and human rights.  In this seminar, we explore the connections between health and human rights in a variety of contexts.   By the end of the course, students should be able to articulate a human rights perspective on health and describe the health effects and health system responses violations of human rights.  In the seminar, we will address some of the following questions (among others): What are human rights?  Are human rights universal? Is there a human right to health?  What are the effects of human rights violations on individuals and societies?  Why do some physicians perpetrate human rights violations? Why (and how) do some physicians put themselves at risk to protect and defend human rights? What are the social responsibilities of physicians? Can societal attempts to achieve justice promote societal “healing”?

Course material includes textbook chapters, journal articles, films, and fiction.  In an attempt to link heart and head, works from the humanities will constitute a significant amount of the required material for the course.  Some films will need to be viewed prior to class.

Each student will be required to:

1. Write a 2-page (double-spaced) “reaction paper” to one of the seminar topics.

2. Write a 12-page to 15-page (double-spaced) paper on any topic relevant to the course.  The paper should demonstrate analytical and original thinking.

3. Participate actively in seminar discussions

4. Lead the discussion for one seminar or co-lead the discussion for two seminars

5. Give an oral presentation on his / her paper topic

Seminar #5: Anticipating Personalized Genomic Medicine: Ethical Implications for Clinical Practice and Society

Faculty: Eric T. Juengst, PhD

Director, Center for Bioethics

Professor, Department of Social Medicine, Department of Genetics

Time: Tuesdays 1:00-2:50 (FALL)

Seminar Description:

This seminar is designed to familiarize medical students with the ethical and social challenges they may face as genomic research is “translated” into clinical care.  Topics will include ethical and social challenges raised by the spread of predictive genetic testing and pharmacogenomics screening, the expanding panels available for prenatal diagnosis and newborn screening, the commercial and public health uses of genomic information, and the prospects for human gene therapy. The course will be conducted as a seminar, involving discussions of readings, guest speakers, and student presentations.

The seminar syllabus will be divided into three main parts.  First, we will look to the future, by discussing the promise of “personalized genomic medicine” as a “new paradigm for health care”.  We will then turn to past attempts to apply genetic science to social problems, in order to discuss what sorts of issues geneticists, health professionals, and public policy-makers should be alert to as genomic research advances. Second, we will examine the professional ethic that guides clinical geneticists and genetics counselors today, which is unique within the health professions for its apparent prohibition against practitioners giving professional advice to the individuals and families that come to them for help.  In this section, we look for the rationale for this “non-directive” ethic, and explore some of the issues that it can provoke in the context of reproductive and prenatal genetic testing.   Then we will discuss the tensions that emerge for that ethic with the advent of “multiplex” and “whole genome” approaches to genetic screening and the direct-to-consumer marketing of these more “personalized” technologies.   Third, we will examine the nascent therapeutic side of genetic medicine, to get a sense of the prospects and problems involved with the development of human gene therapies.  The sessions will focus on two current problems:  Should we design human gene therapy interventions that would effect inheritable as well as somatic changes in patients?   Would there be anything wrong with using those interventions to attempt to improve particular traits in our children?

Seminar Requirements:

After the first introductory session, students will choose which of the remaining sessions they would like to lead.  Students will be required to write a substantive essay on a topic related to the course.

Seminar #6: Doctor-Patient CommunicationCommunication With Patient

Faculty: Mara Buchbinder, PhD

Assistant Professor of Social Medicine

Time: Tuesdays 1:00-2:50 (FALL)

Seminar Description:

Why do patients tend to respond differently when asked if they have “some” versus “any” more questions? How can pediatricians resist parental pressure to prescribe antibiotics for viral upper respiratory tract infections? This seminar will provide students with the tools to begin to answer these and other related questions.

Medical communication is shaped by both interpersonal dynamics and large-scale social forces. Bridging perspectives from anthropology, sociology, and the communication sciences, this seminar will offer students an opportunity to think critically and reflexively about clinical communication and doctor-patient relationships. We will explore the nature and role of norms in regulating doctor-patient conduct and examine various communicative challenges that arise in specific types of medical encounters. We will also discuss and assess some of the solutions offered by researchers for improving doctor-patient communication. Course materials include book chapters, journal articles, and audio and video data recorded in actual medical consultations.

By the end of the semester, students will be expected to: 1) recognize and explain how interpersonal and communicative factors influence the medical encounter and health outcomes; 2) be familiar with social scientific methods and theories for the study of doctor-patient interaction; and 3) apply this knowledge to the analysis of recorded medical visits.

Possible Seminar Topics:

  • Approaches to the Study of Doctor-Patient Interaction
  • Power, Authority, and Expertise
  • Explaining Illness
  • Questioning in Medicine
  • Prescription Practices
  • Difficult Patients and Sensitive Topics
  • Bad News
  • Gender in the Medical Encounter
  • Pediatric Interactions
  • Cross-Cultural Encounters
  • Medical Interpreting
  • Closings

Seminar Requirements:

  1. Attendance, preparation, and active participation in class discussions
  2. Leading one seminar discussion and writing a short reading response (2-3 pages)
  3. Data Analysis Exercise
  4. Final paper (8-10 pages)

Seminar #7: Racial and Ethnic Disparities in Health: Progress and Community ImpartCommunication

Faculty: Giselle Corbie-Smith, MD, MSc

Professor of Social Medicine and Medicine

Time: Tuesdays, 1:00-2:50 p.m. (Fall and Spring)

IMPORTANT NOTE: This seminar will meet every other week during both the Fall and Spring semesters.  Since it meets only every other week, it has the same number of class sessions as other seminars that meet weekly during one semester.

Seminar Description:

Why do some groups have better health than others? How do individual, environmental, structural and contextual factors contribute to racial differences in health outcomes? Besides the luck of the draw (our genetic inheritance), people are exposed to different educational, economic, and familial circumstances that lead them in varying directions. They pursue life's pleasures, endure stress or danger from difficult work situations, and seek support from friends and family…all in different ways, with different impacts on their health.

Environmental influences on health include social and economic factors such as income, education, employment status and working conditions, social networks and community cohesion. Income and education are among the most potent determinants of health. At a community level, disease and death rates are higher in residential areas that have the greatest gap in income between the rich and poor.

This two semester seminar will examine these relationships with the incidence and prevalence of chronic illness ranging from diabetes, cancer, and heart disease and examine the role that environmental influences, current and future, might play in reducing or reinforcing current health disparities. The seminar will take the form of a “lab” setting where students will work as part of a multidisciplinary research workgroup examining the role of environmental context in chronic disease. Each seminar meeting will start with a student led journal club that draws on seminal articles as well as contemporary literature on environmental influences on chronic illness.

Students will also develop mentored research projects within the context of ongoing research led by UNC faculty.

Seminar Requirements:

1.         Seminar members will take responsibility for the journal club, which involves meeting with Dr. Corbie-Smith, completing additional readings for that session, and preparing a handout for the class.

2.         Throughout the year students will be expected to attend meetings of the research team with which they are paired and to meet individually with workgroup faculty to ensure progress on the research project.

3.         The written assignments will include a series of journal entries based upon a synthesis of the class materials as well as the submission of an abstract, essay and/or manuscript based on the mentored research that is completed during the year.